Is Long-Term Anticoagulation Required after Stent Placement for Benign Superior Vena Cava Syndrome?

Summary

This is a retrospective review of all de novo SVC stents placed at a single institution over a 9 year period for benign SVC syndrome. In total, 58 patients were identified with benign SVC syndrome, the majority of which were SIR TCVO Type 4 (SVC) obstructions (N = 53). The remaining were Type 3 (bilateral brachiocephalic veins) obstructions. All patients underwent stenting with a variety of stents, frequency of stent selection not described. Technical success was 100% with two major complications, both of which were pericardial hemorrhage (no procedural mortality).

Following stent placement, anticoagulation was then administered at the discretion of the treatment team. 19/58 patients were anticoagulated due to other pre-existing conditions. 17/58 were anticoagulated due to stent placement; the remaining 22/58 were not anticoagulated. The authors noted no difference in these groups in terms of symptom recurrence or percent stenosis on follow-up imaging. It should be noted that overall, 50% of patients required re-intervention, one of whom eventually underwent surgical bypass.

Commentary

This study is useful in showing the clinical success of SVC stents in the setting of benign SVC syndrome. It also demonstrated that while successful, up to 50% of patients will require re-intervention, when driven by clinical symptomatic parameters. A well-known and observed major complication of SVC occlusions, pericardial hemorrhage, is demonstrated here, well-managed with either a covered stent or a pericardial drain.

The authors conclude that stent placement for benign SVC syndrome may not require anticoagulation if confirmed on subsequent studies. Additional studies do seem needed, given the small sample size of this retrospective study. There is no discussion as to the power of this study, and in the figures, the confidence intervals suggest that a difference in measured outcomes may be present but not distinguishable, given the current study population.

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Haddad MM, Thompson SM, McPhail IR, et al. Is Long-Term Anticoagulation Required after Stent Placement for Benign Superior Vena Cava Syndrome? J Vasc Interv Radiol. 2018; 29(12): 1741-1747.

Post Author:
Daniel P. Sheeran, MD
Assistant Professor
Department of Radiology and Medical Imaging
Division of Vascular and Interventional Radiology
University of Virginia